Diagnostic errors (DE) and medication safety in the home (MSH) are two emerging health care issues receiving increasing attention for their impact on patient safety. Strategies to prevent DE and MSH for an increasingly diverse population are critical to ensuring equitable care and outcomes for all patients. This report highlights key issues related to disparities in DE and MSH and provides recommendations on key areas that require further exploration and funding to advance the field of disparities in DE and MSH.

This Guide was developed as part of the CMS Equity Plan for Improving Quality in Medicare and is designed to assist hospital leaders and stakeholders focused on quality, safety, and care redesign, as well as HIINs, QIN-QIOs, and other stakeholders engaged in readmissions-related quality improvement activities. The Guide was prepared for the CMS Office of Minority Health by the Disparities Solutions Center at Massachusetts General Hospital in partnership with NORC at the University of Chicago. Racial and ethnic minority populations are more likely than their white counterparts to be readmitted within 30 days of discharge for certain chronic conditions. Social, cultural, and linguistic barriers contribute to higher rates of readmissions in these populations.

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This Guide offers action-oriented guidance for addressing avoidable readmissions in this population by providing:

• an overview of key issues related to disparities in readmissions;

• a set of activities that can help hospital leaders address readmissions in this population; and

• strategies aimed at reducing readmissions in diverse populations.

Click here for more information on Centers for Medicare & Medicaid Services Office of Minority Health.

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The Disparities Solutions Center at MGH and Abt Associates, Inc. in Cambridge, MA, were awarded a four year contract by the Agency for Healthcare Research and Quality (AHRQ) to develop tools to reduce medical errors and improve care for LEP patients in hospitals. The project used a mixed methods approach to:

• identify the role of language and cultural barriers on patient safety events;

• document how hospitals are addressing the safety of LEP and culturally diverse patients; and

• provide guidance and tools for how hospitals can address these issues.

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The final products include a Hospital Guide and a TeamSTEPPS Training Module focused on improving interprofessional team communication to reduce medical errors for LEP patients.

The report on Healthcare Disparities Measurement provides practical recommendations for healthcare organizations to increase their portfolio of race, ethnicity, and language data collection strategies and to use those data to develop disparities-sensitive measures. This report is intended to guide organizations in disparities and quality measurement through the following strategies:

• Data Collection: Building the Foundation

• Disparities Measures and Indicators: What to measure

• Methodological Approaches to Disparities Measurement: How to Measure and Monitor

• Priorities and Options for Quality Improvement and Public Reporting of Healthcare Disparities

Small medical practices play an important role in the care of patients with diverse needs. These practices often have limited infrastructure and face significant barriers to providing the highest quality health care. If small practices are to provide accessible, effective and efficient care for vulnerable patients, they will need additional attention, resources and support. Given the proportion of care these practices provide, especially in underserved urban and rural areas, failure to provide adequate help in adapting to the new demands for health information technology, quality, and accountability could greatly impair the chances for successful health care reform.

To understand the needs of small practices in providing the best quality care, the National Committee for Quality Assurance (NCQA) launched a quality improvement demonstration program for small physician practices serving minority populations. With funding from The California Endowment, NCQA provided grants and technical assistance to small practices (5 physicians or less). The goal of the project was to learn what types of resources and tools these practices need in order to conduct and sustain quality improvement activities, especially for diverse populations.

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Created in partnership with the National Committee for Quality Assurance (NCQA)

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Research has shown that racial and ethnic disparities in health care have an impact on quality, safety, cost, and risk management. Addressing disparities has been acknowledged by the National Quality Forum and the Joint Commission as an essential component of quality. Despite this, few hospital leaders have equity, and identifying and addressing disparities, as a priority. The goals of this Guide are to:

• highlight the evidence for racial and ethnic disparities in health care and provide the rationale for addressing them, with a focus on quality, cost, risk management, and accreditation;

• highlight model practices—hospitals and leaders who are actively engaged in addressing disparities and achieving equity; and 
• recommend activities and resources to help hospital leaders initiate an agenda for action in this area.

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Executive Summary

PowerPoint Presentation (Appendix B)

Disparities & Quality Presentation (Appendix E)

Leading Change Presentation PDF (Appendix F)

Just as a quality report allows hospital executives, physicians, and staff to examine quality of care across multiple dimensions, an equity report highlights potential inequalities in utilization, care processes, outcomes, and patient experience. By building on existing quality reporting efforts, an equity report helps examine the extent to which a hospital provides equally high quality care to all patients, regardless of their race, ethnicity, language, socioeconomic status, and other characteristics.

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Creating Equity Reports: A Guide for Hospitals is a resource provides practical information on how to collect data on race, ethnicity, language, and socioeconomic status and how to use those data to develop an equity report that will allow your hospital to take action.

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Funded by the Robert Wood Johnson Foundation, with additional support from the Office of the Attorney General of Massachusetts.

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Executive Summary

The Healthcare Equity Blueprint offers strategies and practices that can be tailored to individual hospitals to address equity in providing quality care. The Blueprint is a starting point for designing and implementing interventions to address racial and ethnic disparities in health care. Aspects of this Blueprint apply to numerous health care settings, but the primary focus is on hospitals. In addition, the Blueprint should be considered “a work in progress, “to be improved and modified by hospitals that use it.”

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The proposed improvement strategies are grouped into the following five categories:

• Create Partnerships with the Community, Patients, and Families

• Exercise Governance and Executive Leadership for Providing Quality and Equitable Care

• Provide Evidence-Based Care to All Patients in a Culturally and Linguistically Appropriate Manner

• Establish Measures for Equitable Care

• Communicate in the Patient’s Language and Understand and be Responsive to Cultural Needs and Expectations

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The Blueprint provides recommended tools, resources, and guidelines on the collection and measurement of data related to addressing health care disparities. Executives and governing bodies may use this Blueprint to organize and prioritize the goals, strategies, expected outcomes, and performance benchmarks for addressing health care equity within their established strategic planning process.

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This guide provides a framework for hospitals and care systems to stratify patient race, ethnicity and language data and use them to identify and address health care disparities. Each hospital or care system can approach stratifying data differently; however, the general framework for the stratification effort is similar. In the guide you will find sample dashboards and outlined steps.

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